Computers Boost Brain Power in MS, Mental Illness

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In another study, a cohort of patients with MS who had 12 weeks of computer-based cognitive training showed increased activation of the prefrontal cortex and posterior cingulate cortex, areas of the brain involved in the performance of complex tasks.

Computer training is showing promise in improving cognitive abilities in patients with conditions as disparate as schizophrenia and multiple sclerosis (MS), researchers reported.

After 16 weeks of intensive targeted treatment, patients with schizophrenia were significantly better able to identify words they had generated themselves from those supplied by others (P=0.02), according to Karuna Subramaniam, PhD, and colleagues from the University of California San Francisco.

This ability to discern stimuli as originating from oneself versus from outside sources is a key deficit in schizophrenia, and the improvement seen in these patients "raises the exciting likelihood that the neural impairments in schizophrenia -- and undoubtedly other neuropsychiatric illnesses -- are not immutably fixed, but instead may be amenable to well-designed interventions that target restoration of neural system functioning," Subramaniam's group wrote online in Neuron.

In another study, a cohort of patients with MS who had 12 weeks of computer-based cognitive training showed increased activation of the prefrontal cortex and posterior cingulate cortex, areas of the brain involved in the performance of complex tasks, according to Massimo Filippi, MD, of Vita-Salute University in Milan, Italy, and colleagues.

"Most intriguingly, our study showed brain functional changes that were possibly induced by the treatment, which in turn might reflect the neurobiologic substrates of the improvement of the cognitive performance," the Italian researchers reported in the March Radiology.

The past two decades have seen major advances in neuroscience research, revealing much about the mechanisms involved in learning and the resulting changes in cortical plasticity.

To see if the neural abnormality known as reality monitoring in schizophrenia can be attenuated by cognitive training, the California researchers enrolled 31 patients with longstanding disease along with 15 healthy controls.

The patients were randomized to receive 80 hours of intensive computer training or an equivalent amount of time in the laboratory playing computer games.

The training consisted of exercises in visual, auditory, verbal, and social memory.

Reality monitoring was assessed by initially presenting the patients with a series of simple noun-verb-noun sentences, in which the tester either provided the second noun (the rabbit ate the carrot) or withheld it, so patients had to come up with a suitable word themselves.

Then, during functional MRI, patients attempted to recall for each word whether they provided it themselves or it was given to them by the tester.

In healthy participants, the researchers explained, recalling whether a word had been self-generated or provided by someone else is associated with greater functional MRI activity in the dorsal rostral area of the anterior cingulate cortex and medial prefrontal cortex.

Schizophrenic patients, in contrast, show no such activity.

However, after the computer training, the patients not only correctly identified the word source, with a large effect size (0.86), but also showed significantly more activity in the medial prefrontal cortex.

"After 16 weeks of intensive training of component cognitive processes, the schizophrenic patients began to 'normalize' their brain-behavior associations during performance of an untrained higher-order reality monitoring task such that they more closely resembled healthy subjects," Subramaniam and colleagues wrote.

Moreover, six months later the participants were showing improved social functioning.

"Thus, it is possible to significantly improve brain function in schizophrenia, even in patients who have been ill for an average of 20 years," they observed.

In the MS study, 20 women with relapsing-remitting disease were randomized to receive computer-based training focusing on information processing, attention, and executive function, or to act as controls.

The researchers tested for effects on these domains by using the Stroop test, which measures attention and flexibility, during functional MRI.

"Significant correlations were found between functional MR imaging changes in activation during the Stroop interference condition and improvements of performance on attention and executive neuropsychologic tests [r = −0.74 to 0.79, P<0.0001)," wrote Filippi and colleagues.

The researchers also found that treatment effects seen on MRI were maintained during a resting state, whereas deterioration occurred in controls.

There were no changes in volume of gray matter or white matter with the treatment, which was an unexpected finding and may be explained by a loss of plasticity caused by the MS process itself.

Limitations of the study included its small sample size, short follow-up, and the absence of a healthy control group.

"Clearly, a longer follow-up (which is currently ongoing) is required to determine whether the observed effects persist and if they are specific to the critical elements of the intervention," the Italian researchers concluded.

The schizophrenia study was supported by the National Institute of Mental Health.

One of the researchers in that study is an employee of Brain Plasticity Institute, which has a financial interest in computerized cognitive training programs, and another is a consultant to the company.

Some investigators in the MS study disclosed financial support from various companies including Merck-Serono, Teva, Biogen, Bayer-Schering, and sanofi-aventis.

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